In the case of accidental death resulting directly from an accidental bodily injury, and occurring within 365 days of the accident, $100,000 accidental death benefit will be paid to your beneficiary in addition to the basic life benefit. An additional $10,000 is payable if your seat belt was properly fastened while travelling in a private passenger automobile.
To initiate the AD&D Claim process, your beneficiary should obtain from the Benefits Office a Group Life Claim Report and an Insurance Accidental Death Claim Form.
These should be completed and sent to the Benefits Office together with:
- a copy of the newspaper clipping, if any
- a copy of the autopsy or police report
- TWO original Death Certificates or Funeral Director’s Statements of Death.
In the case of accidental loss of any member of the body (hands or feet), or loss of sight, hearing or speech, resulting directly from an accidental bodily injury and occurring within 365 days of the accident, you will receive either The Principle Sum ($110,000) or a portion thereof depending on the type of loss. Please see the benefit booklet for a complete description of the benefits payable, as well as other benefits covered under the policy.
To initiate the Claim, obtain from the Benefits Office the following forms:
- Insurance Accidental Injury Claimant’s Statement, and
- Insurance Accidental Injury Claim Attending Physician’s Statement.
These forms should be completed and sent within 90 days to the Benefits Office together with a written explanation of how the loss occurred. All documents should be copied before submission to the Benefits Office. Neither the originals nor copies will be returned.
ACCIDENTAL DEATH — COMMON CARRIER BENEFIT
In the case of death resulting from an accident of a common carrier (bus, train, ferry, plane, etc.), an additional $220,000 would be payable to your beneficiary. This is in addition to the basic accidental death benefit and the basic life benefit. (If the body of a Member has not been found within a year of the forced landing, stranding, sinking or wrecking of a conveyance in which he was an occupant, he is deemed to have suffered Loss of Life in the absence of any evidence to the contrary). Contact the Benefits Office to initiate a claim.